Unnecessary Medical Care?

I recently heard that a lot of medical care is unnecessary, including many tests and operations, as well as prescriptions. What’s your take on this?

– December 25, 2017

You may have heard about a 2017 study from Johns Hopkins University School of Medicine, in which 2,106 doctors across the U.S. were surveyed for their views on unnecessary medical care. The respondents estimated that about 20 percent of care is unnecessary, including 22 percent of prescription drugs, 24.9 percent of tests, and 11.1 percent of procedures. The Institute of Medicine estimated in 2010 that unnecessary medical services add up to $210 billion annually. Study leader Martin Makary, M.D., M.P.H. noted that unnecessary medical care “is a leading driver of the higher health insurance premiums affecting every American.”

The doctors surveyed blamed nearly 85 percent of overtreatment on physicians’ fear of malpractice suits. The researchers wrote, however, that physician perceptions about the prevalence of malpractice suits “may be greater than the reality of the problem,” pointing out that only two to three percent of patients harmed by negligence sue their doctors and that over the past decade, paid malpractice claims have declined by nearly 50 percent.

The physicians responding attributed 59 percent of unnecessary care to pressure from patients who feel that more care is better care. Similar results emerged from a 2014 telephone survey sponsored by the Robert Wood Johnson Foundation. Here, more than half of the health care practitioners participating said they would authorize an insistent patient to receive a medical test they believed to be unnecessary. The Hopkins researchers say that patient education through shared decision-making results in more conservative (meaning less) care. They point to research showing that patient decision aids are linked to significant reductions in elective surgery and a 19 percent lower likelihood of patients receiving antibiotics for upper respiratory infections, most of which are viral in nature.

The survey also found that doctors blame 38 percent of unnecessary care on the difficulty they have accessing patients’ prior medical records.

The researchers reported that medical specialists and physicians with at least 10 years of experience after residency were more likely to believe that doctors perform unnecessary procedures when they profit from them. Asked to suggest how to eliminate unnecessary care, the doctors surveyed listed training medical residents on appropriate criteria for care, increasing access to outside health records, and creating more evidence-based treatment guidelines.

“Not surprisingly, physicians implicated their colleagues (more so than themselves) in providing wasteful care. This highlights the need to objectively measure and report wasteful practices on a provider or practice level so that individual(s)…can see where they might improve,” said Daniel Brotman, M.D., a professor of medicine at Johns Hopkins and one of the study authors.

We’ve long known that unnecessary medical care is widespread and costs us billions per year. Some 30,000 deaths per year among Medicare recipients alone are due to unnecessary care. As a patient, you can protect yourself from unnecessary tests, medication or procedures by carefully questioning doctors about the need for them.

Andrew Weil, M.D.

Martin A. Makary et al, “Overtreatment in the United States.” PLOS ONE, September 6, 2017, doi.org/10.1371/journal.pone.0181970

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